玻璃体腔注射曲安奈德

Introduction

Macular oedema is the main cause of visual loss in diabetic patients,affect-ing around 30%of the patients who have had the disease for more than 20years (Klein et al.1984).The Early Treatment Diabetic Retinopathy Study (ETDRS)investigated the role and the uniformization of photocoagulation for the treatment of diabetic macular oedema (DMO).In this study,focal or grid macular photocoagulation showed a 50%reduction in the risk of develop-ing moderate visual loss in 3years.However,in 24%of the treated eyes,visual acuity (VA)was maintained or became worse (Early Treatment Diabetic Retinopathy Study 1985).Many studies have demonstrated VA and macular thickness improve-ment after intravitreal injections in diabetic patients with macular oedema refractory to treatment with photoco-agulation.These studies involve the use of intravitreal triamcinolone ace-tonide (Martidis et al.2002;Jonas et al.2003a;Massin et al.2004;Gillies et al.2004,2006;Larsson et al.2009),and more recently the use of intravitreal bevacizumab (Haritoglou et al.2006;Arevalo et al.2007;Scott et al.2007;Fang et al.2008;Lam et al.2009).The DRCRnet study determined,however,that at the end

Comparing intravitreal

triamcinolone acetonide and bevacizumab injections for the treatment of diabetic macular oedema:a randomized double-blind study

David Leonardo Cruvinel Isaac,Murilo Batista Abud,Kariza Aiko Frantz,Alan Ricardo Rassi and Marcos Avila

Department of Ophthalmology,Federal University of Goias,Goiania,Brazil

ABSTRACT.

Purpose:To compare the effect of a single intravitreal injection of triamcinolone acetonide and bevacizumab in reducing macular thickness,which was measured by optical coherence tomography (OCT)in patients with diabetic macular oedema (DMO).

Methods:The patients received a single intravitreal injection of 1.25mg bev-acizumab in one randomly selected eye and 4.0mg triamcinolone acetonide in the contralateral eye.Central foveal thickness measurement (CFT)with OCT was taken at the initial visit and at the 4-week,12-week and 24-week visits.

Results:Eleven patients (22eyes)were enrolled and statistically analysed.CFT reduced in the eyes treated with triamcinolone and those treated with bevacizumab in weeks 4and 12(p <0.05).At the 24-week follow-up,no significant difference was noted,relative to the initial paring the two groups treated with dif-ferent drugs,a statistically significant difference in CFT in weeks 4and 12was noted,with a more significant reduction in triamcinolone-treated eyes (p <0.05).Regarding visual acuity (VA),patients treated with triamcinolone had improvement in VA at 4-week (p =0.02)and 12-week follow-up (p =0.01),while the group treated with bevacizumab had VA improvement at 4-week follow-up (p =0.02).Among the eyes treated with triamcinolone,intraocular pressure (IOP)measure-ment of more than 21mmHg was found in three eyes (27.3%).

Conclusions:Intravitreal triamcinolone proved to be more efficient in reducing DMO,providing longer lasting visual improvement,relative to bevacizumab.Eyes treated with triamcinolone had the highest percentage increase in IOP.Further studies are needed to corroborate these findings.

Key words:bevacizumab –complications from diabetes –diabetic retinopathy –macular oedema ⁄therapy –triamcinolone acetonide ⁄administration &dosage –triamcinolone acetonide ⁄therapeu-tic use –visual acuity

Acta Ophthalmol.2012:90:56–60

ª2009The Authors

Journal compilation ª2009Acta Ophthalmol

doi:10.1111/j.1755-3768.2009.01817.x